Apr 14, 2020
By: Sarah Begley | Elemental
In his new book, former Surgeon General Vivek Murthy argues for the health benefits of social connection
With so many Americans under shelter-in-place orders because of the Covid-19 pandemic, loneliness is building in homes around the country. For public health experts like Dr. Vivek Murthy, who served as surgeon general under the Obama administration, that disconnect is reason for alarm.
In fact, well before the first case of Covid-19 surfaced, Murthy was at work on a book about the loneliness epidemic, Together: The Healing Power of Human Connection in a Sometimes Lonely World. “I never imagined when I wrote the book that it would end up being as relevant as it is at this particular moment,” he says.
Elemental caught up with Murthy ahead of his book’s April 28 publication to talk about staying healthy and connected in lonely times, the impact of the virus on the medical profession, and how public health experts continue to feel muzzled.
Elemental: Your new book is about the loneliness epidemic. What are the negative health consequences of loneliness, and what might happen to lonely people who are sheltering in place right now?
Dr. Vivek Murthy: We know that chronic loneliness has consequences. It certainly depresses our mood. And in terms of our health, people who struggle with loneliness also have an increased risk for cardiovascular disease, dementia, depression, and anxiety. Loneliness is also associated with a shorter lifespan. So, it’s important that we recognize that loneliness is more than just a bad feeling — it’s a bad feeling that has consequences for our happiness as well as for our physical health.
With social distancing, there’s a risk that we will deepen the loneliness we’re experiencing and incur a “social recession,” if you will, as a result of prolonged separation from each other. I think the key part for me, though, is recognizing that it does not have to be that way. There’s an alternative pathway, which is that we use this opportunity to recognize and refocus on the power and importance of our relationships with each other, and that we commit to prioritizing our relationships even after Covid-19 is over. And which path we walk down will ultimately depend on the decisions we make today.
Admitting you’re lonely feels like admitting that you’re not likable, and nobody wants to feel that way.
How do you recognize when you’re lonely versus anxious or depressed?
It’s not always easy to tell the difference, because loneliness can sometimes look like depression or anxiety or irritability or anger. This isn’t to say everyone who’s depressed is lonely or everyone who’s anxious is in fact lonely. With that said, I think one of the ways we know we’re lonely is, one, we start permitting ourselves to ask ourselves that question.
As we live in a very extroverted society, people feel a great fear about admitting to themselves or other people that they may in fact be lonely, because admitting you’re lonely feels like admitting that you’re not likable, or that you’re not lovable, or there’s something wrong with you in terms of your social skills. And nobody wants to feel that way. So, I think not only do we avoid talking to other people about those feelings, but we often even deny them to ourselves.
But I think once you recognize that loneliness is incredibly common and that nearly everyone has probably experienced loneliness at some point in life, if you also recognize that loneliness is actually a natural response to lacking social connection and not evidence that we’re broken or dysfunctional, I think it makes it a bit easier to admit to ourselves that we’re feeling lonely.
The second thing that you can ask yourself is, “Am I having meaningful, fulfilling interactions with people each day?” Everyone has a different amount of social connection that they need in their life: Some people may find one meaningful conversation a day to be plenty; others may find it to be hardly enough. Some may need really meaningful conversations with a large group of people, and others may need it with just one person. But we all need some degree of meaningful connection. And if we’re not careful, we can go for long periods of time without having an open, honest conversation with a friend or being vulnerable with somebody we love.
How do you actually go about boosting that feeling of connection?
One of the keys here is to recognize that small steps can make a big difference when it comes to building a connected life. And I mention this because the prospect of trying to build social connections in your life, if you feel you’re lacking in them, can be really daunting.
One thing I recommend to people is that they spend just 15 minutes each day reaching out to someone they love, ideally videoconferencing with them so they can see their face and hear their voice, but even calling or writing to them to say, “Hey, I’m thinking about you, and I want to know how you’re doing.”
The second thing we can do is focus on the quality of our time with people and eliminate the distraction that so often infiltrates our conversations. Much of that distraction emanates from our phones, where we might be checking Instagram or looking at email or Googling a question that popped into our head even while we’re speaking with somebody else on the phone and sometimes even in person. Even a small amount of time that we give somebody else when they have our full attention can be extraordinarily powerful.
The last one I’ll mention is this idea of service. When we serve other people, we shift the focus from ourselves onto someone else, and we remind ourselves that we have value to bring to the world. This becomes so essential, because when we become chronically lonely, one thing that happens is our focus shifts increasingly to ourself as we worry about our safety and well-being, but that can make it harder to build connections with somebody else when our focus is increasingly internal.
The other thing that happens, which is counterproductive when it comes to loneliness, is that chronic loneliness actually starts to erode our self-esteem. We start to believe the reason we’re lonely is that we’re not likable or that something might be wrong with us. And service is powerful because it breaks both of those patterns, shifting the focus away from us, reaffirming the value we add to the world.
I think in this time of Covid-19, service can be simply checking on a neighbor who might be struggling because they’re older and at higher risk for Covid-19 and unable to go out. It could be dropping off food to a friend who might already have been struggling with loneliness or depression before physical distancing began and now is having an even harder time. Those small acts of service can go a long way toward helping us feel more deeply connected to others, even though we may not be able to be physically close to them.
What role does human touch play in this, especially for those who are sheltering in place alone? Do you need to hug people and hold hands with people to be healthy?
Touch is incredibly important as part of the human experience. Our ancestors relied on human touch to form and strengthen bonds with each other. Touch can accelerate a feeling of connection and releases hormones in our body that engender trust and build connection. Sometimes we think touch in intimate relationships is what matters, but [it’s really] touch across the board — it’s when you give a hug to a friend; it’s even the experience of shaking hands with somebody or patting someone on the back, which, in a moment, can help us feel like more connected to another person.
So, the absence of touch does make it more challenging, but this is one of those times when we have to figure out how to compensate for our lack of ability to see people in person and feel their touch. (I should also just say parenthetically that if you’re living at home with other people and you’re all quarantining together and nobody has symptoms, you can certainly touch the people in your home.)
We miss a lot when we don’t have human touch, but that’s why I think it’s all the more important that we recognize that and do our best to compensate as best we can by intentionally building in opportunities to be with our friends virtually, share with them openly, and listen to them deeply.
Is there any upside for those of us who are sheltering at home with a partner or a loved one? Is this a time to hit the reset button and make sure these relationships are sustaining us?
Absolutely. I think this is an opportunity to reset, not just for individuals, but I think for society more broadly, as we ask the deeper question, “What really matters in life?”
When I think about all the conversations I’ve had with people who were in their final days and final hours of life, sitting there in the hospital by their bedside, those conversations were never about the promotions people got or the titles they acquired or the size of their bank account. Those conversations were always about people’s relationships, about the people they loved, the people they were going to miss, the people they wished they had spent more time with. That’s what we talk about in these final moments of life, and it’s a reflection of what truly matters to us.
This is our opportunity as individuals, as families, as communities, and as a society to recenter and recommit to building those relationships in our day-to-day lives. If we do that, then I think we’ll come out more fulfilled and healthier and just more equipped to come together and deal with the big problems we’re facing as a society. Whether that’s health care or climate change or inequalities or any of the other long list of challenges we’re dealing with as a planet.
What other health consequences, good or bad, do you think might come out of this period of sheltering in place? I’m thinking about, on the negative side, the inability to get to the doctor for a routine visit, or a lot of people seem to be drinking more. But on the positive side, also more time to work out, more time to cook healthy meals. Where do you think the balance is going to fall on all these issues?
I think it’s going to vary widely between people. Some families I’m talking to are saying they are going for more walks together, they’re having dinners together regularly, which they never used to do. And they’re just, frankly, just being together more often, which has its challenges, but it feels good in the long run. And then there are other people I speak to who are finding that this is a really stressful time, having to balance so much and take care of kids and work all at the same time while dealing with the economic stresses of losing income.
I’m also worried about the drop-off in routine care. It’s one thing to slow down elective procedures and not see the doctor for things that aren’t urgent today, but what’s not urgent today could become urgent in two weeks or in four weeks.
Some of this also comes down to how we all deal with stress in different ways. One of the people I work with closely, for example, just went through a very stressful family experience, and the way she deals with stress is she would do yoga every morning with her husband, and they would go on three- or four-mile hikes to clear their heads, and they would cook together in the evening just for the relaxing activity. That’s pretty healthy. Other people may deal with stress by drinking alcohol or by using drugs or by, frankly, engaging in violence, whether it’s toward their family members or toward strangers.
One of the great ironies here is that one of the most potent ways to reduce stress is to spend time with people we love, and we’re faced with a great amount of stress at a time when one of our most potent stress relievers is taken away from us. But that’s why I think, again, it’s so important that we find new ways to connect with each other virtually, even though we can’t be together physically.
We will come away from this with a greater appreciation for just how dependent we are on each other when it comes to our health.
How do you think this pandemic is changing awareness about public health issues more broadly?
I do think people will come out of here far more savvy about public health than perhaps they ever wanted to be. For example, I do think many, many more people will understand the importance of washing your hands and covering your mouth when you cough and staying home when you’re sick. This will help reduce not only the transmission of Covid-19 but also the transmission of flu and other respiratory illnesses that we worry about.
I also hope we will come away from this with a greater appreciation for just how dependent we are on each other when it comes to our health. It’s easy to say that health is all about personal responsibility and we should all make good decisions for ourselves, but the reality is far more complicated. We know that in the case of motor vehicle accidents, how other people drive makes a difference in how safe you are. We know that how much other people pollute the environment makes a difference to your health as well. And in this case, what we’re seeing is that whether or not people are responsible about staying home when they’re sick affects our ability to stay safe and healthy.
How might you speculate that this could affect future generations’ interest in becoming medical professionals? On the one hand, it’s very inspiring to see what doctors and nurses are doing for all of us right now. And on the other hand, they’re just so exposed.
I hope it will increase people’s interest in serving in the health care profession, whether that’s nursing or being a physician or a respiratory therapist or any number of roles that are served each day in the hospital and clinics. Our health care workers are the heroes of the Covid-19 response. What they’re doing is truly extraordinary, and in many cases, the risks they are taking are greater than necessary because they don’t have the personal protective equipment that they need and deserve. But I think there’s a sense of mission, purpose, and sacrifice that they are bringing to their work that I think is truly inspiring.
It’s an incredibly rewarding profession. I’m just reminded of how much I deeply admire the colleagues I’ve worked with who are on the front lines today, who are taking some big risks, but they’re doing so because they know it matters and that each of us has a role to play in ensuring that the society is healthy. So, I hope it’ll inspire people to join the profession. We need good doctors and nurses, now and always.
Around a month ago, there was a lot of talk about public health experts feeling muzzled. I’m curious if you think public health experts, particularly those currently working for the government, feel like they can speak truthfully and get the right messages out there at this point
Oh, no. No. I mean, I think there are a few who do and do so bravely, like Dr. Tony Fauci, but I don’t at all think that most of the public health officials who are working in the federal government feel they could comfortably go to a microphone and speak the truth about what science tells us about Covid-19 without potentially paying a price for that. So, no, I think, still, public health experts at the federal level, I think still very much have to toe a certain line and be careful about what they say.
And I think whenever scientists are not comfortable speaking openly and communicating directly with the public, then we suffer as a society, because messages don’t get across as clearly or are delayed in transmission. We know very clearly with pandemic responses that speed equals lives saved. And the more quickly you act, the more lives you save, and the less suffering people have to endure. And that’s why it’s of the essence that you have the shortest possible path between science and scientists and the general public.